Life Long Weight Management

Making the Leap to a Healthy Life

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It all seems so simple: eat less, exercise, lose weight. Yet
approximately 44 million Americans are overweight, and dieters are spending an
average of $30 billion a year on commercial weight loss programs to take it
off.

Yet no matter what approach most people use to diet, their weight loss
is temporary. The weight they lose almost always returns in the long run.

That's the conclusion of a 13-member panel of obesity, metabolic and
other experts convened by the National Institutes of Health (NIH) last spring.
The panel examined the nature and effectiveness of approaches to voluntary
weight loss and control.

Studies show as much as two thirds of the weight lost through dieting is
regained within one year, and almost all the weight is regained within five
years. Other weight loss techniques such as behavior modification, exercise
and drugs--even in controlled settings--usually produce only short-term
results.

Given this discouraging dieting outlook, many experts are beginning to
shift their focus to the concept of weight management. Adopting a healthy
lifestyle with a reasonable approach to caloric consumption and exercise, may
ultimately offer more promise in managing overweight than traditional dieting
strategies.

Overweight: What and Why

Although precise definitions vary among experts, overweight has been
traditionally defined as 10 to 20 percent above an optimal weight for height
derived from statistics.

Some scientists argue, however, that the amount and distribution of an
individual's body fat is a significant indicator of health risk and therefore
should be considered in defining overweight. Abdominal fat has been linked to
more adverse health consequences than fat in the hips or thighs. Thus,
calculations of waist-to-hip ratio are preferred by some health experts to
help determine if an individual is overweight.

Regardless of the definition, the prevalence of overweight among
Americans has increased during the last 20 years, adversely affecting public
health. Overweight is associated with elevated serum cholesterol, high blood
pressure, diabetes, gallbladder disease, gout and certain types of cancer.
Because of its serious impact on cardiovascular health and lung function, the
National Heart, Lung and Blood Institute is launching a special obesity
education initiative, targeted both at high-risk individuals and the general
population.

Although the basic mechanism of overweight involves an imbalance between
caloric intake and energy expenditure, it's unclear why this imbalance occurs
in certain individuals. However, it is clear that overweight is more than
simply a matter of willpower. A complex combination of genetic, environmental,
cultural, socioeconomic and physiological factors are believed to contribute
to this condition.

Surveys indicate that 33 to 40 percent of adult women and 20 to 24
percent of adult men are trying to lose weight, whether they need to or not.
Another 28 percent each of males and females are trying to maintain their
weight.

In women, the percentage trying to lose weight does not differ
significantly among various ethnic groups, even though black and Hispanic
women have a higher prevalence of overweight than white women. Among men,
Hispanics report the highest rates of attempted weight loss.

While it's human nature to want "quick results," it appears
most people take weight loss more seriously. The average reported time on a
weight loss regimen is five or six months.

Decisions to lose weight are motivated by a variety of factors: the
desire to improve self-image, reduce disease risk, improve overall health, or
avoid societal "discrimination" against overweight people.

In one survey, women cited appearance as a more important reason for
losing weight than fitness, while the reverse was true for men. But, according
to Judith Rodin, Ph.D., professor of medicine and psychiatry at Yale
University, more and more women are beginning to embrace the fitness
mentality. "The look for the '90s woman is still lean, but now there is
the added pressure to be fit. The emphasis on health and fitness is a new
social force pushing increased body awareness," she said.

When it comes to losing weight and keeping it off, many Americans are
called but few are successful. Yet, individuals who have "beaten the
odds" in weight management share some commonalties in how they've
achieved success.

Based on more than 20 years of working with overweight clients, John
Foreyt, Ph.D., director of the Nutrition Research Clinic at Houston's Baylor
College of Medicine, offers the following recommendations for successful
weight management:

Regular physical activity. Exercise not only increases
caloric expenditure, it increases feelings of well-being and perceived
energy level. Studies also suggest exercise can be effective in regulating
appetite. However, the challenge is to incorporate exercise into other
life-long habits.

Social support. Long-term weight regulation is easier when
individuals are supported in their goals by family, friends, colleagues
and treatment support groups.

Internal motivation. Those who demonstrate internal
motivation such as "I'm doing this to be in charge of my life,"
are more successful in weight management than those who focus on external
reasons like "fitting into a new pair of jeans."

Positive health benefits. Focusing on positive health
benefits such as an ability to walk further without being winded,
increases the chances of successful long-term weight management.

Smaller, more frequent meals. Eating smaller, more frequent
meals throughout the day helps maintain blood sugar levels and avoids
feelings of starvation, which can lead to bingeing.

Gradual changes. Those who make gradual changes in diet and
exercise are more likely to successfully manage their weight in the long
run, than those who make dramatic changes at once.

Weight Management Approaches

Managing caloric intake is the most popular way people attempt to lose
or maintain healthy weight. Results of the Food and Drug Administration's
recent Weight Loss Practices Survey indicate that many people are using
reduced-calorie foods as part of their weight management strategies, including
low-calorie dressings, low-calorie sweeteners, low-fat frozen desserts,
low-fat cheeses, diet breads and light alcohol beverages.

Vitamins, meal replacements. over-the-counter products, weight loss
programs and diet supplements are also being used by men and women in
decreasing order from 28 to 3 percent. While certain diets alter the
proportion of calories from fat, carbohydrate and protein, the NIH panel
concluded the effectiveness of such changes appear to be more variable than
cutting back on total calories alone.

Some studies show, however, that overweight individuals do consume more
fat in the diet than their slender counterparts. Gram-for-gram, dietary fat
provides more than twice the number of calories as carbohydrate or protein.

Pound-for-pound, how does that effect of caloric restriction compare to
exercise? Evidence suggests that greater amounts of weight are lost more
quickly with caloric restriction than with increased caloric expenditure. But,
when exercise is added to dietary change, even greater weight losses are
possible.

Steven Blair, P.E.D., an exercise physiologist at the Institute for
Aerobics Research in Dallas, conducted a one-year study comparing volunteers
who dieted with those who dieted and exercised. The diet plus exercise group
lost more weight and fat and had a greater improvement in the waist-to-hip
ratio than the diet-only groups.

According to Blair, exercise builds and preserves the body's muscles.
"When you diet, your body loses both muscle and fat. The goal is to
maximize fat loss and minimize muscle loss.

"Exercise builds muscle tissue, and muscle cells burn more calories
while you are resting than do fat cells. The more muscle you have, the more
energy you burn while at rest," he said.

Blair also cited exercise's beneficial role in the prevention of
overweight as well as in long-term weight maintenance. Overweight men and
women appear to benefit from exercise even if they remain overweight, with
more active individuals having lower rates of morbidity and mortality.

Weight Cycling

Although the health consequences suffered by those who repeatedly lose
and gain weight need further exploration, at least one study has found serious
adverse effects of such weight cycling.

American and Swedish researchers analyzed weight fluctuations and later
health problems over a period of 32 years in more than 3,000 participants in
the ongoing Framingham Health Study.

The researchers found that people who repeatedly lose and regain weight
have an overall higher death rate. They also may be at greater risk of heart
disease and some cancers than those whose weight remains stable or steadily
increases, even if they are overweight.

In addition, programs that claim rapid weight loss, which rarely are
successful over the long-term, can cause depression, anger and bingeing. Those
who attempt such programs may ultimately regain weight faster and weight more
than when they initially started.

The NIH panel underscored the importance of being realistic when
selecting any personal weight management strategy. It takes time to gain
weight, so losing it will take time as well. Modest goals and a slow, steady
course of weight loss will maximize the probability of both losing weight and
keeping it off.

In the end, the panel advised that individuals should view their weight
loss goals as part of an overall long-term strategy to achieve a healthier
life.

Reprinted from the International Food Information Council Foundation, 1992